Abstract: The precordial catch syndrome is frequently mentioned as part of a long differential diagnosis of chest pain in children. It is an extremely common complaint but remains underrecognized. This review describes the distinctive features of the syndrome and points out that this is not a diagnosis of exclusion. Emphasis is placed on the need for taking a careful history to elicit the diagnostic features of the syndrome and performing a thorough physical examination. Diagnostic testing is usually unnecessary. Familiarity with the features of precordial catch syndrome should be helpful to primary care providers caring for children. ********** The precordial catch syndrome is an exceedingly common yet underrecognized cause of benign chest pain in children and adolescents. The syndrome has a remarkably consistent, characteristic presentation and is therefore easily diagnosed. Nonetheless, it frequently leads to elaborate testing and/or referral to a pediatric cardiologist and can be a source of considerable anxiety for many patients, their families, and their physicians. The syndrome was first described and graphically termed precordial catch by Miller and Texidor in 1955. (1) They characterized the condition as presenting with sudden onset, with sharp, stabbing, well-localized precordial pain, and reported its occurrence in 10 patients, 1 of whom was Miller himself. Later authors coined the phrase Texidor's twinge. (2) In 1978, Sparrow and Bird (3) reported 45 healthy patients with the same form of benign chest pain and commented on its underappreciated frequency. Pickering discussed the syndrome in a short article in 1981, (4) and in 1989, Reynolds put together the first report of children with the condition in the United States. (5) To date, these four reports constitute the body of literature identifying precordial catch syndrome as a common complaint. Although the syndrome is mentioned in a number of other publications (2,6-10) it is included only as part of the broad differential diagnosis of chest pain or as a form of idiopathic chest pain. The syndrome is so common, h owever, that it merits wider recognition by the medical community. Chest pain is a frequent complaint of children and adolescents. During a 9-week period, Driscoll et al (11) prospectively studied 43 pediatric clinic patients with that primary complaint. They identified six diagnostic categories of chest pain and concluded that it was common, usually benign, and rarely of cardiac origin. A number of subsequent studies and reviews drawn from outpatient, (8'9'12) emergency, (2,6,13-15) and cardiology (7,10,16-20) settings have reported similar conclusions. Often, these studies tabulate the causes of the complaint in their series of patients, usually including precordial catch syndrome under a category of idiopathic, functional, or miscellaneous causes. The intent of most of these reports was to outline the differential diagnosis of chest pain and propose an appropriate diagnostic evaluation plan. Precordial catch syndrome is underemphasized relative to the frequency of its occurrence. Recently, Selbst (2,6,13,14) studied and described a large number of pediatric patients with the primary complaint of chest pain. He emphasized the benign and noncardiac etiology of the chest pain (2,6,13,14) and appropriately...